Understanding Ambiguous Grief in Infertility and Baby Loss

Ambiguous grief refers to a type of grief that lacks closure or clear understanding, making it particularly difficult. It often involves situations where a person is physically present but psychologically or emotionally absent (like in cases of dementia or addiction), or where something important is lost but not fully gone (like a missing person). It’s a term coined by Dr Pauline Boss, and it refers to a type of grief that is complicated because the loss is unclear, incomplete, or difficult to define.

In my work in relation to fertility and baby loss I see this a lot in my clients and how difficult they find it to allow themselves to grieve because this is not grief as most people know it. 

In the context of infertility, ambiguous grief can manifest in several ways:

1. Uncertainty and unpredictability

Infertility often involves a lack of closure — there’s no clear "end point" or definitive outcome. Many individuals or couples who struggle with infertility may experience ongoing uncertainty, as there’s no guarantee they will ever conceive, and treatments or interventions might not work. This constant state of limbo can create an emotional void that’s hard to articulate or resolve.

2. Loss of a hoped-for future

Parents who experience infertility might grieve the child they never had, the future they envisioned, and the family they hoped for. The loss is real, but there’s no tangible “child” to mourn. This form of anticipatory grief can feel confusing and isolating because society often does not recognise it as a legitimate loss.

3. Relationship strain

Partners might process the loss differently, leading to further feelings of isolation or emotional distance. For some, the inability to conceive becomes a source of tension, guilt, or frustration, which can complicate the grieving process.

The partner may also experience ambiguous loss if they feel emotionally distanced from their loved one, who is focused on trying to get pregnant, or if they are experiencing guilt about not being able to fulfil their shared dreams of parenthood.

4. Internal conflict

Infertility can lead to grief over what might have been, but at the same time, they may feel a need to remain hopeful or keep trying. The internal tension between grieving the loss of one’s fertility and striving for a future with children creates a sense of being caught between two conflicting emotional states—loss and hope—which is central to the idea of ambiguous loss.

Because of the ambiguity and uncertainty, many people experiencing infertility might not feel like they have the space or permission to grieve in the same way people who experience other more clear-cut losses might. It can be helpful for individuals dealing with infertility to seek validation and support for their grief, recognising that the emotional impact of infertility is real, even if it doesn’t always fit the traditional mould of loss.

In the context of miscarriage and stillbirth, this kind of loss can be particularly profound.

Here’s why:

Miscarriage

After a miscarriage, parents often experience a loss of a future they had imagined, but it’s not a “loss” in the traditional sense where a person or object is definitively gone. The baby may not have been born, or perhaps it was only a few weeks into pregnancy. This creates an emotional disconnect because the loss doesn’t feel fully tangible or clear.

Parents may grieve not just the baby they never got to meet, but also the hopes, dreams, and plans they had for that child’s future.

Stillbirth

With stillbirth, the loss can feel similarly ambiguous because, although the baby has passed, parents might be left with mixed emotions. They may have already formed a bond with the child during pregnancy and are now facing a loss of both the child and a future they had envisioned. In some cases, there may be a sense that the baby’s presence in their life is still unresolved, particularly if there was a prolonged or traumatic pregnancy.

In all situations, the key element of ambiguous loss is that the person is physically gone but not fully absent in terms of emotional connection, memories, or the ongoing relationship. Parents often find themselves in a state of mourning without closure. It can feel like they’re still waiting or holding onto something that no longer exists in the way they imagined it.

The emotional impact is complex, because it's not just about the person who’s gone — it’s about the loss of identity, the loss of a future that will never come to pass, and often a lack of recognition or societal understanding of the type of grief involved.

In conclusion, ambiguous grief from baby loss and infertility requires patience, self-compassion, and understanding that it’s OK not to have clear answers or resolutions. It’s a unique form of mourning that asks for emotional flexibility, as well as a recognition of the complexities of both love and loss. The journey through this grief may be non-linear, but it is a valid and deeply personal experience that deserves space and time for healing.